Objec ves. Sports- Related Concussions in Student- Athletes: A 2015 Update 8/30/15

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1 Sports- Related Concussions in Student- Athletes: A 2015 Update Joel S. Brenner, M.D., M.P.H., F.A.A.P. Medical Director, CHKD Sports Medicine Program Director, CHKD Sports Concussion Program Associate Professor of Pediatrics Eastern Virginia Medical School PLAY The only comprehensive sports medicine program in the region AND the only program dedicated to youth Objecves Regarding concussions in the student-athlete the learner will know the current: Diagnosis, evaluation, treatment and return to play standards Reasoning behind intervention (SIS/ PCS/ CTE) Virginia law protecting student-athletes 1

2 Complex pathophysiologic process affecng the brain, induced by traumac biomechanical forces secondary to direct or indirect forces to the head that disrupts the funcon of the brain. (CDC 2007) Doesn t have to be a hard hit Bell rung or A Ding BRAIN INJURY Epidemiology of Sports- Related Concussion in the United States Approximately 3.8 million sports- related concussions occur each year Studies show concussion resulng in LOC account for less than 10% of injuries 6 2

3 Signs and Symptoms of a Concussion? Physical Headache Nausea/vomiting Dizziness Balance problems Visual problems Sensitivity to light or sound Cognitive (thinking) Confusion Memory problems Feeling foggy Feeling slowed down Difficulty concentrating Emotional Irritable Sadness Anger More emotional Nervousness Sleep Drowsiness Sleeps too much Sleeping too little Trouble falling asleep Tip #1 If an athlete did not have LOC don t assume they did not have a concussion IF IN DOUBT, SIT THEM OUT 3

Grading Scales of Concussions NO MORE GRADES 1. Colorado 14. Rugby Football league (UK) 2. American Academy of Neurology 15. Federaon Internaonale de Ski 3. Cantu 16.

Gersoff 18. The Jockey Club 19. Rugby Union 20. Rugby League (Australia) 21. Schneider 22. Kulund 23. Kolb 24. Saal 25. Nelson 26.

4 Grading Scales of Concussions NO MORE GRADES 1. Colorado 14. Rugby Football league (UK) 2. American Academy of Neurology 15. Federaon Internaonale de Ski 3. Cantu 16. Amateur Boxing Associaon 4. Maroon 17. Auto Cycle Union (UK) 5. Hugenholz 6. Wilberger 7. Roberts 8. VNI 9. AMSSM 10. Ommaya & Gennarelli 11. Ommaya 12. Torg 13. Gersoff 18. The Jockey Club 19. Rugby Union 20. Rugby League (Australia) 21. Schneider 22. Kulund 23. Kolb 24. Saal 25. Nelson 26. Parkinson Follow- Up Evaluaon Evaluaon should occur during acute period of injury Clinical Interview (signs and symptoms) Neurologic exam Balance Occulovesbular exam Neuropsychologic exam (i.e. ImPACT) 4

5 Neuropsychological Tesng: What is it? One tool in a toolbox Neurospychologic Findings Disturbances of : memory aenon informaon processing speed reacon me 5

6 Symptoms Time Headache Dizziness Nausea Deficits on neurocognitive testing (ImPACT) Recovery from Concussion in High School Athletes 40% by week 1 60% by week 2 80% by week 3 CHILDREN RECOVER SLOWER THAN ADULTS Collins et al, Neurosurgery 2006; N=134 What are we trying to prevent? Post- Concussion Syndrome Second Impact Syndrome Chronic Traumac Encephalopathy Healthy Brain Damaged Brain(18 yr old) 6

7 Keeping Quiet Can Keep You Out of the Game E60 Concussion Story Treatment Avoid cognive and physical exeron Avoid 2 nd hit to brain Sleep Medicaon* Physical therapy* Psychotherapy* 7

Coming Soon 22 Return to Play Criteria No signs or symptoms Normal neurological exam Normal balance Neuropsychological exam back to baseline Back to school full- me And then

8 Coming Soon 22 Return to Play Criteria No signs or symptoms Normal neurological exam Normal balance Neuropsychological exam back to baseline Back to school full- me And then return to play progression No acvity Light aerobic exercise Sport specific exercise Non- contact training drills Full- contact pracce Return to Play (Game) *24 hr minimum at each stage 8

9 Tip #2 Do not clear an athlete to return to play unl they are back to baseline in your office Tip #3 Do not clear an athlete to return to play from the emergency department The Team Athlec Trainer Physician (PCP and ED) Athlete and Parent School Personnel Sports Medicine Physician Neuropsychologist Neurologist Neurosurgeon 9

10 Prevention Prevenon Dawn Comstock- preliminary results

11 31 Code of Virginia Section Policies on concussions in student-athletes Educaon of parent, athlete and coaches Proof of educaon Disconnue play if suspect concussion Wrien clearance by license health care provider determined by BOE Licensed HCP may be a volunteer Effective July 1, 2011 White House Healthy Kids & Safe Sports Concussion Summit May 29 th,

12 CHKD Concussion Program The Team Concussion Legislation Federal State Regional Local PLAY 12

Concussion 2013 A Program For Logan County

Concussion 2013 A Program For Logan County Boyd C Hoddinott MD, MPH Logan County Health Commissioner ----------------------------------- Kristy Wisner PT, DPT Mary Rutan Physical Rehab Center Consensus